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skillful treatment is of most value if complications arise.

One in every ten cases of pneumonia in ordinarily healthy people proves fatal. In specially selected young men, as soldiers, the death rate from pneumonia is only one in twenty-five cases. On the other hand, pneu

monia is the common cause of death in old age; about seventy out of every hundred patients who die from pneumonia are between sixty and eighty years of age. Infants under a year old, and persons enfeebled with disease or suffering from excesses, particularly alcoholism, are also likely to die if stricken with the disease.

The patient should go to bed in a large, well-ventilated, and sunny room. The temperature of the room should be about 70° F., and the patient must not be covered so warmly with clothing as to cause perspiration. A flannel jacket may be made to surround the chest, and should open down the whole front. The nightshirt is worn over this; nothing more. Daily sponging of the patient with tepid water (85° to 90° F.) should be practiced. The body is not to be all exposed at once, but each limb and the trunk are to be separately sponged and dried. If the fever is high (104° F.) the water should be cold (77° to 72° F.), and the sponging done every three hours in the case of a strong patient. Visitors must be absolutely forbidden. No more than one or two persons are to be allowed in the sick room at once.

The diet should consist chiefly of milk, a glass every two hours, varied with milk mixed with thin cooked cereal or eggnog. It is wise to give at the beginning of the disease a cathartic, such as five grains of calomel followed in twelve hours by a Seidlitz powder, if the bowels do not act freely before that time. To relieve the pain in the side, if excruciating, give one-quarter grain morphine sulphate,1 and repeat once, if necessary, in two hours. The application of an ice bag to the painful side frequently stops the pain, and, moreover, is excellent treatment throughout the course of the disease. The seat of pain usually indicates that the lung on that side is the inflamed one, so that the ice bag should be allowed to rest against that portion of the chest. Water should be freely supplied, and should be given as well as milk even if the patient is delirious.

The bowels are to be moved daily by glycerin suppositories or injection of warm water. Dover's powder in doses of five grains is useful to assuage cough.

It may be repeated once, after two hours' interval if desirable, but must not be employed at the same time as morphine. After the first two or three days are passed, or sooner in weak subjects, give strychnine sulphate, one-thirtieth grain, every six hours in pill or tablet form. The strychnine is to be continued until the temperature becomes normal, and then reduced about one-half in amount for a week or ten days.

1 Caution. Dangerous. Use only on physician's order.

while the patient remains in bed, as he must for some time after the temperature, pulse, and breathing have become normal.

CONSUMPTION; TUBERCULOSIS OF THE LUNGS; PHTHISIS.-This disease demands especial attention, not only because it is above all others the great destroyer of human life, causing one-seventh of all deaths, but because, so far from being a surely fatal disease as popularly believed, it is an eminently curable disorder if recognized in its earliest stage. The most careful laboratory examinations of bodies dead from other causes, show that very many people have had tuberculosis at some time, and to some extent, during life. The reason why the disease fails to progress in most persons is that the system is strong enough to resist the inroads of the disease. The process becomes arrested by the germs being surrounded by a barrier of healthy tissue, and so perishing in their walled-in position. These facts prove that so far from being incurable, recovery from consumption frequently occurs without even our knowledge of the disease. It is only those cases which become so far advanced as to be easily recognized that are likely to result fatally. Many more cases of consumption are now cured than formerly, because exact methods have been discovered which enable us to determine the existence of the disease at an early stage of its development.

Consumption is due to the growth of a special germ in the lungs. The disease is contagious, that is, it is

capable of being communicated from a consumptive to a healthy person by means of the germs present in the sputum (expectoration) of the patient. The danger of thus acquiring the disease directly from a consumptive is slight, if one take simple precautions which will be mentioned later, except in the case of a husband, wife, or child of the patient who come in close personal contact, as in kissing, etc. This is proved by the fact that attendants in hospitals for consumptives, who devote their lives to the care of these patients, are rarely affected with consumption. The chief source of danger to persons at large is dust containing the germs derived from the expectoration of human patients, and thus finding entrance into the lungs.

Consumption is said to be inherited. This is not the case, as only most rarely is an infant born actually bearing the living germs of the disease in its body. A tendency to the disease is seen in certain families, and this tendency may be inherited in the sense that the lung tissue of these persons possesses less resistance to the growth of the germ of consumption. It may well be, however, that the children of consumptive parents, as has been suggested, are more resistant to the disease through inherited immunity (as is seen in the offspring of parents who have had other contagious diseases), and that the reason that they more often acquire tuberculosis is because they are constantly exposed to contact with the germ of consumption in their everyday home life.

It is known that there are certain occupations and diseases which render the individual more susceptible to consumption. Thus, stone cutters, knife grinders and polishers, on account of inhaling the irritating dust, are more liable to the disease than any other class. Plasterers, cigar makers, and upholsterers are next in order of susceptibility for the same reason; while out-ofdoor workers, as farmers, are less likely to contract -consumption than any other body of workers except bankers and brokers. Among diseases predisposing to consumption, ordinary colds and bronchitis, influenza, pneumonia, measles, nasal obstruction causing mouthbreathing, and scarlet fever are the most important.

No age is exempt, from the cradle to the grave, although the liability to the disease diminishes markedly after the age of forty.

About one-third more women than men recover from consumption, probably because it is more practicable for them to alter their mode of life to suit the requirements of treatment.

It is, then, the neglected cold and cough (bronchitis) which offers a field most commonly favorable for the growth of the germs in the lungs which cause consumption. And it is essential to discover the existence of the disease at its beginning, what is called the incipient stage, in order to have the best chance of recovery. It becomes important, therefore, that each individual know the signs and symptoms which suggest beginning consumption.

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